Treatment

Mild Cases

Can often be managed with dandruff therapies:

Anti-Dandruff Shampoos
Over-the-counter shampoos containing zinc pyrithione, selenium sulfide, or ketoconazole are first-line.
Scalp Hygiene
Shampoo 2–3 times a week to remove excess oil and yeast buildup.

Moderate to Severe Cases

Require dermatological evaluation and prescription medications:

1. Prescription Anti-Dandruff Shampoos

Ketoconazole 2%
Ciclopirox 1%
Selenium sulfide 2.5%
Coal tar preparations Used 2–3 times a week and left on the scalp for 5–10 minutes.

2. Topical Steroids

Betamethasone lotion or foam for the scalp.
Hydrocortisone cream for the face or body lesions. Short-term use is advised to prevent skin thinning or steroid dependence.

3. Topical Antifungals

Ketoconazole, ciclopirox, or miconazole creams can be used on facial or chest lesions to reduce yeast colonization.

4. Topical Keratolytics

Salicylic acid (2–5%) and sulphur-based gels help loosen thick scales and facilitate shampoo penetration.

5. Oral Antifungals

Itraconazole or terbinafine may be prescribed in resistant, widespread, or immunocompromised cases.

6. Oral Retinoids

Isotretinoin may be used when seborrheic dermatitis coexists with oily skin or acne. It reduces sebaceous gland activity, which indirectly limits fungal growth.

Newer adjuncts: Studies in 2024 show that probiotics, low-dose calcineurin inhibitors (like pimecrolimus), and photodynamic therapy may offer promising benefits in recalcitrant cases.